Total Knee Joint Replacement

Total Knee Replacement web based movie

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms.

Indications

Total knee replacement surgery is commonly indicated for severe osteoarthritis of the knee. Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It often affects older people.

In a normal joint, articular cartilage allows for smooth movement within the joint, whereas in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. All of these factors can cause pain and restricted range of motion in the joint.

Your doctor may advise total knee replacement if you have:

Severe knee pain which limits your daily activities (such as walking, getting up from a chair or climbing stairs).

Moderate to severe pain that occurs during rest or awakens you at night.

Chronic knee inflammation and swelling that is not relieved with rest or medications

Causes

The exact cause of osteoarthritis is not known, however there are a number of factors that are commonly associated with the onset of arthritis and may include:

Injury or trauma to the joint

Fractures at the knee joint

Increased body weight

Repetitive overuse

Joint infection

Inflammation of the joint

Connective tissue disorders

Diagnosis

Your doctor will diagnose osteoarthritis based on the medical history, physical examination, and X-rays.

X-rays typically show a narrowing of the joint space in the arthritic knee.

Procedure

The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee.

The surgery is performed under spinal or general anesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Then the damaged portions of the femur bone are cut at appropriate angles using specialized jigs. The femoral component is attached to the end of the femur with or without bone cement. The surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with bone cement or screws. Your surgeon will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, similar to the original meniscus cartilage. The femur and the tibia with the new components are then put together to form the new knee joint. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component. With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed, drains are inserted and a sterile dressing is placed over the incision.

Post-operative care

Rehabilitation begins immediately following the surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. Knee immobilizers are used to stabilize the knee. You will be able to walk with crutches or a walker. A continuous passive motion (CPM) machine can be used to move the knee joint . Continuous passive motion is a device attached to the treated leg which constantly moves the joint through a controlled range of motion, while the patient relaxes. Your physical therapist will also provide you with a home exercise program to strengthen thigh and calf muscles.

Risks and complications

As with any major surgery, possible risks and complications associated with total knee replacement surgery include:

Knee stiffness

Infection

Blood clots (deep vein thrombosis)

Nerve and blood vessel damage

Ligament injuries

Patella (kneecap) dislocation

Plastic liner wears out

Loosening of the implant

If you find difficulty in performing simple activities such as walking or climbing stairs because of your severe arthritic knee pain, then total knee replacement may be an option for you. It is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume your normal activities of daily living.

MeetCharles V. Toman, MD

Board Certified, Fellowship Trained Orthopedic Surgeon

I am 16 weeks post-op from my rotator cuff surgery by Dr. Toman and am very pleased with the outcome. I never once felt that I was in “assembly line surgery” but rather in the care of a dedicated compassionate surgeon from my initial visit through rehab. Charlotte County is very fortunate to have an […]

My first occasion to hear of Doctor Toman was on talk radio 1580AM. He was giving an interview on a less invasive procedure for knee replacement. I called a friend in New Hampshire who asked if I knew of an orthopedic doctor here in Punta Gorda to replace both of his knee joints. Next my […]

I just want to thank Dr. Toman for the new knee he installed in my right leg. You might not believe this but, 11 days after the operation I played 18 holes of golf at St. Andrews South in Punta Gorda. The next day I played 9 holes too. I swear it’s true. I have […]

I am almost 82 years old and have been suffering night and day with my left shoulder for 5 and a half years. Two weeks after Dr. Toman did my reverse shoulder replacement I was able to lift my arm over my head without any pain and no pain medication. For me this doctor is […]

I would like to first start off by saying that Dr. Toman is an awesome Surgeon.I went to see him for the pain I was having in my right elbow. After having an MRI done he diagnosed me with a torn tendon and decided to “Scope” my elbow. So on May 13th 2010 Dr. Toman […]

Dr. Charles Toman demonstrated his professionalism and dedication in caring for my broken wrist which healed very quickly and nicely. Just a note of thanks for all his attention and I wish him well in his continuing endeavors. Thanks again Dr. Toman.

Dr Toman gave me back my life in March of 2010. Dr. Toman performed Hip Scope surgery on my right hip, and literally has given me back the ability to do everyday things. Before my surgery I could not walk with out pain or sit for any length of time without getting extremely stiff in […]

Hello, My wife and I have both had surguries performed by Dr Toman, she with hip and knee and I with rotator cuff, each done authoscopically. We are very pleased with the outcomes as we are having quick recoveries. Physical Therapy has been going well next door at SOS Therapy with the Martins. Everyone has […]

It is without hesitation that I highly recommend Dr. Toman and his exceptional support staff to anyone in need of an orthopedic procedure. During the initial office visit he instilled confidence that surgery to repair my rotator cuff followed by occupational and physical therapies would produce positive results thereby alleviating the tremendous pain I had […]

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Dr.Toman did a total knee for me in may.i feel so much better since,you can’t imagine! It’s going to take time for a full recovery,but i am well satisfied with the surgery.Everyone is amazed how fast I’ve come along and how small the scar is.Thank you vary much doc,i really appreciate it.

I would like to thank Dr. Toman and his staff for the excellent service I received before and after my rotator cuff surgery. It has been six months since the surgery and I am able to do everything I did before the injury and with no pain.

I had a hip scope procedure in April 2010 by Dr. Toman. After a few weeks of physical therapy with the Martins I was able to return to my normal activities. The entire recovery time was less than anticipated & the results have been great. It is so nice to be pain free and able […]

As a retired state trooper, and active sports official, I was experiencing severe pain in my shoulder joint that was interrupting my sleep and causing major discomfort. On the recommendation of another doctor I was seeing, I set up a consultation with Dr. Toman. It was agreed that a total shoulder replacement was necessary due […]

Dr.Charles Toman replaced my left knee in October of 2010. In 5 days I was walking, doing my outpatient rehabilitation and exercising. My 90 year old Aunt also had her knee replaced and she was walking, after just one week, to my house (which is about a block away) I can’t thank Doctor Toman enough, […]

Dr. Toman did a complete knee replacement on me in November of 2010. I was only in the hospital 3 days and at the end of 2 weeks I was in out patient therapy. Dr. Toman’s outstanding skill as a surgeon and advance technology had me up and moving well within 6 weeks. His professional […]

In the middle of July 2010 I had an unfortunate fall which resulted in the dislocation of my right shoulder. I was taken to the Portsmouth, NH Hospital where the shoulder was reset. About 12 weeks later the shoulder was still very uncomfortable and it was decided to have further x-rays and MRI which revealed […]

On Feb. 8, 2011 Dr. Toman performed a right total shoulder replacement and muscle re-attachment on me. I was 70/1/2 at the time. His skill was obvious by my recovery time. Ten weeks after surgery I was released from physical therapy. After my surgery Dr. Toman took my wife and son from the waiting room […]

It is one of the best decisions I have made. My shoulder was bothering me to the point that I had trouble sleeping and raising my arm. My wife kept after me to see a doctor. From my first visit with D.Toman, I knew that I had made the correct decision. He lets you know […]

Dr. Toman replaced my left shoulder at Fawcett Memorial Hospital at the beginning of April. I highly recommend Dr. Toman. There has been no pain throughout the procedure and my recovery. Home health care was arranged including physical therapy. Outpatient PT was started after 4 weeks and will be continued during my stay up north. […]